A Monthly Whisper from a Healed Wound: Recurrent Perineal Endometriosis

Abstract

Background: Scar endometriosis is an uncommon manifestation of extra-pelvic endometriosis, most often seen at abdominal or perineal surgical sites. Episiotomy scar involvement is particularly rare, and recurrence after prior excision is even less frequently documented, especially when adjacent to critical structures such as the anal sphincter.

Case Presentation: We report the case of a 37-year-old multiparous woman with cyclical perineal pain and swelling over her episiotomy scar. She had previously undergone surgical excision and short-term hormonal therapy for histologically proven perineal endometriosis. One year later, symptoms recurred.

Imaging with MRI demonstrated a recurrent lesion infiltrating the external anal sphincter. Wide local excision with sphincter preservation was performed. Histopathology reconfirmed endometriosis with free surgical margins. Postoperatively, the patient made an uneventful recovery and remained symptom-free on follow-up.

Conclusion: This case highlights the diagnostic challenges posed by recurrent perineal endometriosis. The constellation of cyclical pain and scar swelling should prompt consideration of this rare diagnosis. MRI plays a pivotal role in operative planning. Complete excision remains the cornerstone of management, as recurrence is strongly associated with incomplete primary resection.